Once again, with my fourth year of medical school completed, it is time for me to break out the inner nerd and share the pictograph of my numerical note-taking. The chart above representing my fourth year of school with obvious end points when interviews finished and graduation approached.

The next chart is a culmination of first, second, third and fourth years combined. Initial observation would suggest that second year was almost twice as difficult as first year if not more so.The deep troughs usually representing times of vacation after exams or between years. The steady third year was a result of various preceptors and the work loads with each specialty. Obviously this would look different for every student depending on their scheduling. Things picked up again in fourth year with interviews, audition clerkships and the match process. Once matched, the intensity levels dropped significantly until the end of school all together.

Thoughts in Retrospection

Attempting to look back and decide on the few things that helped me along the way this last year is proving difficult, but as time passed, I have been looking forward to this post and mentally banking ideas along the way. Below are the top five things I wish I knew before my fourth year of medical school and probably could have been useful before school started.

Stand Tall - It can be difficult to show courage on rotations. Many times preceptors will "pimp" students or question our thinking to the point of making us feel smaller than ever before. Standing tall, using direct answers and showing interest made the difference on more than one occasion. Confidence, even if simulated, lets others know you have what it takes when challenges come.

Read regularly - Medicine is a profession of lifelong learning. Getting into the habit now of seeking the latest research in your field will serve you well when it comes time to managing your own patients. Obviously, there is more to know than can possibly be memorized, but taking an active roll in consistent reading can set you apart from your peers who only read to cram for exams. Make reading a regular part of your study routine.

Follow the rules - While this might seem like a no-brainer, it is surprising how many do not. Whether an assignment to study for the next day, a sterile field you are not to touch or paperwork your school needs, abiding by given instruction will only serve to help make your life easier. You will have a lifelong career where you get to be your own boss. Save your rule breaking and adventure seeking for then. Being a student means you are still governed by the rules of those who decide the receipt of your degree.

Be proactive - Set up clerkships early, arrive on time ready to start everyday and actively look for opportunities to participate in patient care. Having my interview application submitted early allowed me to be on my eighth interview when some students were just starting their first. Procrastination means you may be eating crumbs.

Have fun - This is what you came to medical school to do. You are paying good money to make the most of a four year education, even if long hours of studying depress you. The least you can do is make some friends along the way and have a good time in the process. There are some great memories to be had in medical school, don't miss out.

Medical school is honestly the hardest thing I have ever done in my life. The journey has been amazing to say the least. To be done is not only a dream come true, but a gift only I could have given to myself. I am grateful for all the support my family, friends and readers from around the world have given me along the way. While I do not know what awaits me over the next four years of residency, I am excited to be moving in the right direction. Now to start working on that quarter million dollar student loan.

Question of the Week

A 30 year old male medical student blogger has just graduated and is moving on to residency. If he continues to blog in the little free time he will have, where can his writings be found?